Glasgow Coma Scale (GCS) Assessment
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- เผยแพร่เมื่อ 3 มิ.ย. 2024
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In this lesson we talk about the Glasgow Coma Scale assessment or GCS. The GCS assessment is one of the most important assessments you can do for your patients and its very quick to perform.
We start with a quick lesson on the background of the Glasgow Coma Scale and what it is used for before we move in to talking about the actual assessment and how to score your patient as well as how those scores relate to the various levels of cognitive functioning that your patient is exhibiting.
The assessment starts talking about scoring your patients eye opening and the different points for the category. From there it goes in to the verbal response and the associated scores there. Finally we cover the motor response and how we score what we see in that category.
Finally we cover some pitfalls and problems to watch out for as well as some general guidelines to help you get the most from your GCS assessment.
Our hope is that after this lesson you will have a better understanding of this assessment and what your are looking for in your patient, as well as the importance of what you are seeing and scoring in the overall context of your patients condition!
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CORRECTION: Thank you @TessaCournoyer for catching this mistake! At 21:41 I wrote E4 after just stating it was E3. You're total score would actually be 9 not 10
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Thank you guys so much for watching! Please leave us a like if you enjoyed the video. We truly do appreciate it! Also we love hearing your comments so feel free to tell us what you think of the video. We hope that after this lesson, you will have a good understanding of the simple yet effective and powerful assessment tool called the Glasgow Coma Scale. This assessment will likely be something you perform multiple times a day on each of your patients and you can really utilize this to monitor for the first signs of deterioration in your patients.
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I’m in nursing school and this is the best video I’ve seen for GCS. I’ve been really enjoying your videos.
On May 25th last year I was in a road accident. I was wearing my gear so there were no external injuries but my lungs were filled with blood and my brain was bleeding from 5 places from what I understood. My discharge summary says I had a GCS of 5 when I was admitted to the ICU. After watching this I understand why all the doctors said it's a miracle I'm still alive let alone the fact that I have no disabilities and still able to function normally. Got lucky! Phew!!
WOW! That is an amazing recovery! So glad to hear this!
@shrilayt. How long that you awake from the coma?
@@ivmean1120 I woke up later on the same day or early morning next day. But they tell me I couldn't process the information of where I am and what happened and I thought my life was in danger and tried to chew my way through the ventilator pipe and the restraints, so they sedated me. I was kept sedated for I think 2 days. After that I had calmed down and although I had lost all my memories I understood that I was in an accident and I wasn't trying to break through anything and run. I did have panic attacks at times but my family was there by that time and they would be asked to step into ICU and calm me down.
@@shrilayt Medical Miracles still occur!
It is really a miracle. It is the power of love of your loving ones.
in the first example you gave at minute 22:12: it should be E3,V2,M4 = 9.
Oh my gosh! Great catch! I didn't even catch that in editing. No clue why I wrote E4 after just stating it was 3... Thank you for catching that! 👏
The only video so far that talks in detail about the difference between types of abnormal verbal responses and abnormal motor responses.
Thank you!
Glad to be able to help! :)
Well I am an RN and wound up coding 3 days after cardiac bypass surgery from an allergic reaction and spent 4 days tubed and woke up on a vent and thought I was kidnapped and they were trying to kill me.😱 Well, I am reading through my chart and they scored me 11 while tubed and was trying to figure out how they scored me 11 and my dr ordered rass score of -2.
And I opend up utube and there was your lesson on GCS. PERFECT!🎯Thanks for the education!
Great video, very informative. Explanation was in full, and spot on. I suffered an cerebral aneurysm (SAH) 2009. Following my statement that I had the worst HA in my lifetime, I immediately lost consciousness. Upon arrival of EMS, their eval revealed I was GCS 3. I was airlifted to larger city, developed swelling (angry brain), had coil surgery 3 days later, and was in a coma for 27 days. Following 6 weeks of Phys Rehab, I now walk with a quad cane (balance issues), drive, can do most ADL's without many problems. I cannot write, I also have speech issues, but can read aloud with no trouble. So yes, I bounced back from my GCS of 3. Don't count us out too soon!
Amazing story. Thanks for sharing! Absolutely right about not counting someone out based solely on GCS, especially early in an injury! It's amazing the recoveries we see sometimes!
I'm so glad you are making a recovery! At my church a young lady complained of a horrible headache, collapsed and never woke up. Left behind 3 small children she was homeschooling
@UC5ADeLt8ckSBvfz0C47qbGQ
i was the loser in a motorcycle-on-SUV accident back in 2012, i sustained a severe diffuse axonal injury with the concentration of the impact being to my prefrontal cortex. i came into the hospital at a 3 on this scale. cadavers score a GCS3. i credit neurofeedback with a great deal of my cognitive recovery, but.. honestly i shouldn't even still be here to tell my story. there's a video on here somewhere about my recovery
Been binge-watching your videos! Really appreciate you and what you have done!
Would love to see videos on more in-depth neuro assesment (i.e. MEND assesment), managing pts with TBIs, and differences between different LOCs (stupor, obtundation, semi-comatose, comatose, etc.)!
Thank you so much and I'm really glad you enjoy these videos!
I certainly plan to do more neuro related topics in the future. Not sure of a timeline for anything yet, but they definitely are on the todo list for the future!
Great job. I'm finally on my internship on icu and your videos are just amazing. Thank you so much.
Very important video that we get good information about GCS scale
Excellent video. Thank you for posting. This will be very helpful with the distant learning many nursing schools are doing during this time of social isolation r/t COVID 19
Thank you so much! This video is very helpful, i got so confused about gcs before and sometimes get decorticate and decebrate messed up. After watching this i can totally understand now
Yes!!! So happy to hear this!
Amazing!! I finally understand. Thank you🤎
So incredibly helpful! I’m so grateful (and I know I’m not alone!) in your thoughtful and well-done explanations of subjects we need to know about as nurses. Thanks again and bless you!
Appreciate that Aaron. Truly a labor of love haha. Glad the videos are well received!
This was super helpful for my EMT class. Thanks, this helped me a lot!
So glad you enjoyed the video Aubrey!
Thank you so much for your videos. They are very well done and extremely helpful to me. I recommend them to many people.
Awesome! So glad you enjoy them and thanks for the recommendations!
I'm an EMT and headed to a BSN and hopefully an NP one day! This video has been so incredibly helpful. Thank you for taking the time to create this video. ❤ I am subscribed and binging your videos now!
So glad to help in making these videos! Awesome journey you are on there. One day at a time and you'll get there. So cool. Glad you liked it and welcome aboard!
@@ICUAdvantage 😁😁😁 thank you!
Really it's too helpful,you made in easy way to understand
Glad to hear that!
subscribed! totally helped me for my GCS reporting for our ICU rotation! thanks a lot
So great to hear this! Happy to be able to help.
Wonderfully explained to make it easy and for interpretation of the scores.
Happy to hear this!
thankyou for such a great video about GCS
Our Midterm examination is about to come that is why I am here. This video is very helpful. Thank you for your virtual help.❣
My pleasure and best of luck on your exam!
Thank you for a good review of the GCS. The brief hx was worth your effort.
For the experienced it was also worthwhile. Pt images might have helped but you reviewed the GCS precisely enough.. This was a worthy tutorial of the GCS.
Thank you and thanks for the feedback! Will keep in mind for the future.
Professional and clearly explained
Very much appreciate the feedback! Thank you and glad you enjoyed!
Thanks for the very informative video!! :) I had a confused patient whom I had to check GCS. And the patient was E4, V4 but for motor response, he did not follow my command when I asked him to move his arms. Instead, he frustratingly gave me the bad middle finger! Lol! I just charted exactly what he did.
Ahhh yes, the good 'ol 1 finger assessment that your patient is still in there. :) I recall getting that one time while the family was in there and everyone was so excited and happy to see him give me the bird! haha.
Glad you enjoyed the video though and thanks for sharing the story!
Super super helpful.
Thank you @ICUAdvantage
Really great to hear this. You are very welcome Lydiah!
Very well explained thank you so much.
Glad to hear it!
Quick question, how come we don’t score for pupils reaction to light when we have to check this? This video is so helpful thank you !
Hi! Current second year grad student and future speech-language pathologist here! This really helped me while studying for the Praxis and my comprehensive exam. Thank you!
How cool! Glad this helped Rachel!
@@ICUAdvantage Update: I passed the PRAXIS! Thanks!
Very good explanation. Thank you.
Thank you! Glad you enjoyed it!
Thanks alot,very nice job,well explained, well understood
Really appreciate that. Glad you enjoyed it!
Thanks a lot for this great lecture..
Super helpful. Thank you!!
Awesome to hear! My pleasure :)
Quick question. If the patient only opens their eyes to verbal stimulus, makes incomprehensible sounds, and withdraws from pain, what is the score actually be 9? I am having trouble understanding why the score for eye-opening would be 4 if they only open their eyes to verbal stimulus, which would be 3. If I am misunderstanding please let me know.
Thank you for this!!!
Truly my pleasure Stephanie! Glad you liked it.
Thank you so much it's very useful
Glad it was helpful!
Hi, I am enquiring about coma states in view of my cousin's recent medically induced coma at the Heidelberg University Hospital. Thx for such a great video. I got the jist of most of it and understood the clear layman's explanation style. I wonder then, is the GCS relevant only to comas induced naturally? Have I missed anything regarding medically induced comas? If so then would you pls point me in the right direction so my family can have informed discussions with the hospital in the next few days. All the best.
Thanks for you very professional and informative lectures!!!!!
Appreciate that Carlos! Glad you like them.
@@ICUAdvantage thanks is not enough for people like you who cares about saving People's lives and making our jobs easier. It goes a long way! Many, many thanks!
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Eyes-4
Verbal-5
Motor- 6
Nice!
Amazing explanation thank you 🙏
Wow, so great to hear this! Thank you!
Hello Good day! Just a question if a patient is intubated but fully awake pointing something / instruction something to health care provider that can't determine what it is.. In Verbal assessment, does it fall on INCOMPREHENSIVE WORDS?
Thank you so much. Have a nice day :)
Thank you and you too!
Thanks dude for this lessons
My pleasure!
how about patients who has severe tbi injuries who eyes just never close ? still a 4 an E
also how can I tell if something is abnormal posturing or its contractures.. also some contractures does not allow patients to move abnormally to painful stimuli. how do I assess this and document?
Hi, good explanation.
I want to ask you why best motor response is considered only in upper limb not on lower limbs
Thank you. Its not upper over lower, its just the best response that you get you would score that. So if it was lower and that was better than upper, you'd score off the lower.
Love you for the great lesson, from India💫💅❤
Good understanding
So useful, many thanks
You are welcome!
Excellent! 🎯💯
Nice and valuable information for medical student also.
Awesome glad to hear you enjoyed it!
thnk u smch😍u help me alot🙏🙏
Thank you for this
You're welcome!
I’m approaching my 25th year past my injury and it wasn’t until last year I learned how rare it is for someone who was a GCS 3 at the scene of the accident to have recovered to my level. I was treated at one of the top hospitals at the time for TBIs. (It happened to be the closest one to my accident.) I am more than fortunate in my treatment. Also how my epilepsy began inside the CT scanner upon arrival.
Upon arrival at the hospital I was a 7. I still have the records I ordered for my Paralegal Education later. I was a E3, V2 and M2. Wild! Thank you very much. I can finally understand with better detail what this means. My doctor friend described the M2 as very bad, but I didn’t understand exactly how and why. I now have a permanent vestibular migraine condition that didn’t begin until 14 years later. I believe it has something to do with this and the blood found in the occipital lobe immediately following my injury.
Despite the many surgeries I’m now on SSDI because of my epilepsy. Life is something, eh?
Wow thank you so much for sharing. I'm so sorry to hear that you had to go through this all those years ago, but also glad to hear that you were fortunate enough to find your way in to great care and are still here to be able to share your story. It sounds like it has been a difficult journey for you but you seem to have a great attitude. I wish you all the best and take care!
Without my struggles I wouldn’t be the person I am today. My favorite saying is that: “We’ve all got something.” Whenever anyone freaks out and says that I’ve had it so much worse than anything they’ve experienced, I try to pull them back with this sentence. I cannot imagine how hard it must be to raise children alone and try to work full time. I cannot imagine how hard it must be to have a husband or wife leave the scene and need to explain this to little kids or even the older children. There is plenty I have no idea what it’s like to have happen in my life. I am also very fortunate to know why I have epilepsy. The majority of epilepsy patients have no idea. My only problem is mine is completely uncontrollable. It’s slowly and slowly becoming better managed, but it’s still disabling.
Thank you!
New subscriber here . Thank you Ehdie for informative video
Awesome! Welcome aboard!
please when do you check on these categories for example with the eye opening when will you check for the spontaneous opening eye
I'm not sure I understand your question.
Thanks for the class, I just left hospital, I was on scale 7 and basically I'm all purple because doctors tortured me (but I understand why)
Oh wow. So sorry to hear that you have go through this. Hoping that your recovery is going well!
Really helpful! ❤️
I'm so glad!
Thank you
You're welcome
Excellent video.
Thank you very much!
Thank you for viewing Gsc
Great video‼️
Thank you 🤗
You are the best!
Thank you!
Where does triple flexing of lowers fall into for motor response? Is that worse or better than extension/flexion
Thats spinal reflex and does not score on GCS which is measuring cerebral response
How to assess the eyes properly, does the pentorch needs to be direct to the eyes?
We are just assessing if and how they open their eyes. No need for a pen light or to assess pupil size. Just looking at if they will open their eyes, spontaneously, to voice, to pain, or not at all. Thanks for the question!
4. A 21 year-old male was rushed to emergency room due to road traffic accident. He is gasping for breath and has wound on head and upper extremities, swollen (R) leg, unable to open mouth for bite and raise extremities when asked and complains of severe pain. Based on the scenario, compute the GCS score of the client using the 3 scales.؟
Thanks ♥️♥️♥️♥️♥️
You're very welcome!
Lost me...TBI from surfing and medication dr. Gave me (1997). At least i know what people are talking about now. 20:22
VERY INTERESTED GOOD
Glad you liked it!
thank you sir
You're welcome!
I hope this will help me with my osce
Whats the once?
@@ICUAdvantage the OSCE is a final year nursing physical exam we have to conduct on a "patient" in a simulation here in Australia. We have a patient that deteriorates and one of the scenarios we may get is a patient that becomes confused and declines and we have to recognise this and conduct a full GCS.
Good information
Glad you liked it!
Can a 58 year old person in 4 for 6 days since the day of a car accident after craniotomy recover? Please tell me
Awesome
Ty!
Q - If fine motor muscle movement is lost i.e- Fingers curl and won't straighten or coordinate but abnormal limb flexion/isn't decorticating, would that be considered a M4 please?
If you can't distinguish purposeful movement, but they do withdraw to pain with no posturing present, then yes that'd be a 4.
@@ICUAdvantage Thank you.
Can 4 out of 15 person can recover?
What is the GCS of highly intoxicated person?
Don't have enough info to go on. You would basically just score them according to the scale based on what you observe/assess.
Good
Thanks
If a patient is making some growing sounds spontaneously n openingeyes, but sometimes not showing any visual or verbal response to stimulus. Showing some flexor withdrawal to pain full stimulus. And she is on de corticate posture what could be her GCS.
.
A score is a moment in time and especially with brain injury, this will wax and wane. Just score it based on what you assess at that time. If its a big change down, let the providers know in case there is something causing that change that needs to be addressed.
@@ICUAdvantage Than you so much
What if the patient had decerebrate posture on one side. Frown with pain and heart rate increase with external sound but does not respond
As far as the GCS score goes, we'd want to score the highest that we get for a category, so since the posturing is only unilateral, I'd score the higher score that the other side does. The unilateral posturing is typically a localized lesion/edema that is only impacting part of the lower brain.
For the score, grimacing and HR don't play in to it, but can be valuable information as it probably signifies high level response to pain. Is there no eye opening or vocalization?
Hope that helps and thanks for taking the time to ask the question!
@@ICUAdvantage no eye opening no vocalization brain injury is hemmoraghic stroke to ventricles
So both for E an V you'd score a 1. The question would be on the side that isn't posturing, whats the best they are doing? Withdrawing to pain?
@@ICUAdvantage I'm sorry, let me explain in detail. He had hemmorage in his brain in his third and fourth ventricle. He displayed mild decerebrate posture in both arms. His heart rate would increase upon hearing certain voices and if you moved him around he would frown. He showed mild flexion. If you scratched his feet he would move a little. Slight Gag reflux was present. He could take some breaths on his own but need ventilators. If ventilator was removed he have rapid breathing. They couldn't remove the hematoma with the drainage catheter and refused to do surgery. In this case is there any hope
No eye opening and no vocalization no meaningful movement other than twitching.
Good video... Have my OSCE tomorrow so has helped me alot. Only thing as a glaswegian the way you say Glasgow annoys me 😂 sounds like glass-go when you're saying it 😬😂
😬 Yeeeeeah... I'm definitely saying "Glaz-go"
Glad to hear you could overlook my horrible pronunciation and get something useful out of it 😂
THE BEST VIDEO EVER !!!!!! I'm sorry sir but the video has a mistake at 22.09 minutes . E is 3 right?
Glad you liked it. And yeah, I put a correction in the video description. I for some reason wrote 4 while saying 3. 3 is correct. Total score of 9, not 10.
@@ICUAdvantage aww thank you 😊
E3*
I noticed your example was incorrect it should be E3 V2 M4 = 9
Yup. I wrote out one example and then said a different scenario, then read from what I had written.
Dear my brother and Sister my czn is get accident and right now he is in 7/15 plz guys tell me its possible they can recover ... plz i am waiting for your guys reply thanks . Alot
How is he now?
@@mohammadkhizar6674 no more bro ...
Oh so sad... my czn is in coma frm 3 months
😎
Or if they are incubated temporarily. They cannot give a verbal response.
We use the T modifier to signify this.
GCS for intubated patients is 10T, not 11T
example of GCS total was 9 not 10 i think
Yeah, see the note in the video description
I don't understand. How are you getting dislikes? Do they not like the colors? The detailed information? Or did they suffer from "mouse pad malfunctions"? LOL
Hahah DUDE I know!? I've always wondered. I've convinced myself they meant to hit the like and just didn't notice it was the dislike lol
G
What about the patient? opens his eyes but can recognise me.
The score would be lower on speech because they wouldn't recognise you I suppose
you have too many adds on your video
They are just set for TH-cam to add them in automatically
ICU Advantage literally every 5 mins there’s an add. Most I’ve ever seen on one video
sorry to say that, but it was so boaring that i coukd not watch it for long, that is may be because you just explain too many unneccesary details!
Thanks for the feedback.
I didn't think it was boring at all! It was interesting, clear, and detailed. I learned a lot from this video, and appreciate that ICU Advantage is making this information available to many people.